A Case Study of an Outsourcing Decision Project in a Large Public Organization

Phases in an outsourcing decision project are presented and critical issues are identified. First, there were different definitions of hosting and these different definitions made it unclear what the project was about and thereby the outcome of the project became unclear. This affected project commitment, project outcome project management, and project costs. Second, there were unclear descriptions of how the hosting was made in the organisation. The study suggests that had there been a clearer and more concise description of what the project was about and how the hosting was made a lot of the difficulties could have been avoided

Bilateral Arthrodesis of the Ankle Joint : Self-Reported Outcomes in 35 Patients From the Swedish Ankle Registry

Bilateral ankle arthrodesis is seldom performed, and results concerning the outcome and satisfaction can only sparsely be found in published studies. We analyzed the data from 35 patients who had undergone bilateral ankle arthrodesis in the Swedish Ankle Registry using patient-reported generic and region-specific outcome measures. Of 36 talocrural arthrodeses and 34 tibio-talar-calcaneal arthrodeses, 6 ankles (9%) had undergone repeat arthrodesis because of nonunion. After a mean follow-up period of 47 ± 5 (range 12 to 194) months, the mean scores were as follows: self-reported foot and ankle score, 33 ± 10 (range 4 to 48); the EuroQol Group's EQ-5D™ score, 0.67 ± 0.28 (range −0.11 to 1), the EuroQol Group's visual analog scale score, 70 ± 19 (range 20 to 95), 36-item Short Form Health Survey (SF-36) physical domain, 39 ± 11 (range 16 to 58); and SF-36 mental domain, 54 ± 14 (range 17 to 71). Patients with rheumatoid arthritis seemed to have similar self-reported foot and ankle scores but possibly lower EQ-5D™ and SF-36 scores. Those with talocrural arthrodeses scored higher than did those with tibio-talar-calcaneal arthrodeses on the EQ5D™ and SF-36 questionnaires (p = .03 and p = .04). In 64 of 70 ankles (91%), the patients were satisfied or very satisfied with the outcome. In conclusion, we consider bilateral ankle arthrodesis to be a reasonable treatment for symptomatic hindfoot arthritis, with high postoperative mid-term satisfaction and satisfactory scores on the patient-reported generic and region-specific outcome measures, when no other treatment option is available

The role of iron in rheumatoid arthritis

Iron plays a potential role in oxidative stress-mediated injuries and pathologies e.g. rheumatoid arthritis (RA). Four decades ago it was suggested that iron may have a crucial role in the progression of inflammation in RA. Indeed, free radicals generated by iron can cause damage to lipids, proteins, carbohydrates, and DNA. It is this destructive process that is believed to occur in rheumatoid joints. However, none had differentiated between the role of iron in both acute and chronic phases of the disease and the origin of this 'labile' iron. Since RA cells are chronically exposed to oxidative stress, we have therefore chosen Jurkat cells to be our cell model. We used the parental (J16) cell line was used to mimic the acute phase of oxidative stress and the H2O2-resistant (HJ16) cells to mimic the chronic phase. By using hydrogen peroxide (H2O2) as the oxidising agent, we aim to study the role of iron in acute and chronic phase of oxidative stress and to know its origin. In the present study, we found that both antioxidants and H2O2-induced labile iron are modulated when cells are chronically exposed to H2O2. HJ16 cells contain higher total intracellular glutathione levels and glutathione peroxidase activity than J16 cells while the superoxide dismutase and catalase activity are similar. Haem oxygenase-1 (HO-1) was not detectable nor was it induced in these cell lines; HO-2 on the other hand was expressed but not induced. Although they had the same ‘basal’ LIP and L-Ft levels, J16 cells contain more than 7-fold higher H-Ft levels than in HJ16 cells. It was also found that H2O2-induced labile iron is directly correlated with necrotic cell death. These results are consistent with the conclusion that both antioxidant defence mechanism and labile iron status are modulated in cells chronically exposed to H2O2. We have also shown that the ‘basal’ and ‘H2O2-induced’ NFκB activation was higher in the HJ16 cells. We have also provided a link between labile iron release, lysosomal membrane damage and the ensuing necrotic cell death following H2O2 treatment.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

ANALYS AV EN ORDERHANTERINGSPROCESS : EN FALLSTUDIE PÅ AKZO NOBEL INDUSTRIAL COATINGS AB

Syfte: Syftet med denna studie är att identifiera brister i Akzo Nobel Industrial Coatings orderhanteringsprocess ”Planera och anskaffa”, både angående hur den utförs och mäts, samt ge förslag till hur dessa kan åtgärdas. Forskningsfrågor: 1. I processen ”Planera och anskaffa”: Vilka brister finns i utförandet av processen i nuläget och hur kan de åtgärdas? 2. I processen ”Planera och anskaffa”: Hur kan nyckeltal introduceras för att mäta processens prestation? Metod: Studien har genomförts i form av en typisk, explorativ fallstudie med hjälp av datainsamlingsmetoderna skriftliga källor, observationer och intervjuer. Nyckelpersoner inom varje delprocess i ”Planera och anskaffa” observerades för att sedan utifrån dessa, tillsammans med teori, ta fram intervjuguider till efterföljande intervjuer. Semistrukturerade intervjuer hölls därefter med de inblandade i delprocesserna för att få en bred och rättvis bild av processen. Slutsatser: Ett antal brister identifierades relaterade till processen och dessa delades in i ett antal rekommendationer. Rekommendationerna skiljer sig i storlek och omfattning men överlag kan de delas in i: införa nya aktiviteter, minska dubbelhanteringen och öka kunskapsdelningen. Även ett ramverk togs fram för hur Akzo Nobel Industrial Coatings skall omvandla deras funktionsbaserade nyckeltal till att bli processbaserade. Ramverket består av 5 steg där företaget först ska etablera en länk mellan organisationens prestation och processens, därefter följt av att företaget ska skapa relevanta nyckeltal för att kunna följa upp hur processen presterar, identifiering av kritiska punkter i processen, specificering och utökning av nyckeltalet enligt ett ramverk för nyckeltalsspecificering och slutligen implementering. Exempel på ett nyckeltal som företaget kan använda ges avslutningsvis.Purpose: The purpose of this study is to identify problems in Akzo Nobel Industrial Coatings order fulfillment process "Planning and Sourcing" both on how it is executed and measured, and suggest how these can be addressed. Research questions: 1. In the process “Planning and Sourcing”: What are the problems in the execution of the process and how can they be addressed? 2. In the process “Planning and Sourcing”: How can performance measures be introduced to measure the process performance? Method: The study was conducted as a simple case study with the data collection methods of written sources, observations and interviews. Key employees within each sub-process of “Planning and Sourcing” was observed and then, based on these, along with theory, interview guides were developed. This to get a valid view of the processes. Conclusions: A number of shortcomings were identified related to the process and these were divided into a number of recommendations. The recommendations differ in size and scope, but generally they can be divided into: introduce new activities, reduce double handling and increase knowledge sharing. A framework was developed for the comany to be able to transfom their functional performance measuers into process-based. The framework consists of five steps: 1. Establish a linkage between the organization’s performance and the process output. 2. Develop sound measures that can measure the process performance. 3. Identify critical process steps. 4. Specify and extend the performance measure to fit the “performance measure record sheet”. 5. Implement. Finally an example of a performance measure that can be used was presented

Feasibility of Bariatric Surgery as a Strategy for Secondary Prevention in Cardiovascular Disease: A Report from the Swedish Obese Subjects Trial

Aims. Evaluation of bariatric surgery as secondary prevention in obese patients with ischemic heart disease (IHD). Methods. Analysis of data from 4047 subjects in the Swedish Obese Subjects (SOSs) study. Thirty-five patients with IHD are treated with bariatric surgery (n = 21) or conventional treatment (n = 14). Mean follow-up is 10.8 years. Results. Bariatric surgery resulted in sustained weight loss during the study period. After 2 years, the surgery group displayed significant reductions in cardiovascular risk factors, relief from cardiorespiratory symptoms, increments in physical activity, and improved quality of life. After 10 years, recovery from hypertension, diabetes, physical inactivity, and depression was still more common in the surgery group. There were no signs of increased cardiovascular morbidity or mortality in the surgery group. Conclusion. Bariatric surgery appears to be a safe and feasible treatment to achieve long-term weight loss and improvement in cardiovascular risk factors, symptoms, and quality of life in obese subjects with IHD

Economic evaluation: what are we looking for and how do we get there?

The interest in economic evaluation of alternative strategies for haemophilia treatment has increased through the years. Few studies have actually been undertaken, however, and most of them have been simple cost-minimization or cost-effectiveness analyses. From the perspective of the binational project 'Treatment strategies for severe haemophilia - prophylaxis vs. on-demand', the present paper discusses the pros and cons of different methods for economic evaluation and their data requirements. Severe haemophilia is a rare disease that requires lifelong treatment. In addition, treatment has both short- and long-term effects which are likely to differ between strategies. Accordingly, regardless of the chosen evaluation method, data requirements are non-trivial. Hence, the various problems connected to the generation of data, as well as how they may be addressed, are also discussed

Willingness to pay for on-demand and prophylactic treatment for severe haemophilia in Sweden.

The objective of the present paper was to provide an estimate of the benefits of on-demand and prophylaxis treatment strategies for severe haemophilia in monetary terms. Using the contingent-valuation method, which simulates a missing market by asking people about their willingness to pay (WTP), we asked a representative sample (n = 609) of the Swedish population if they would be willing to pay a specific amount (bid) so that patients with severe haemophilia could receive on-demand treatment and another bid for prophylactic treatment. Different respondents were offered different bids and the bid vector ranged from 71 Euro cents to EUR 130. The order of the bid questions was randomized so that half of the respondents were asked first about their WTP for on-demand treatment, and then about their WTP for prophylaxis, while the order was reversed for the other half of the respondents. The mean estimated WTP (year 2002) was EUR 39 (95% CI 31-47) for on-demand and EUR 65 (95% CI 55-73) for prophylaxis. Our sensitivity analysis showed that the ranking of the two treatment alternatives was robust in that the WTP was greater for prophylaxis in all possible subsets. The point estimates of WTP varied somewhat in subsets defined by individual characteristics, but confidence intervals always overlapped that of the main results. The WTP for on-demand and prophylaxis exceeded the calculated cost of treatment per taxpayer of providing on-demand and prophylactic treatment, respectively, based on our previous result

Health utilities of type 2 diabetes-related complications: a cross-sectional study in sweden.

This study estimates health utilities (HU) in Sweden for a range of type 2 diabetes-related complications using EQ-5D and two alternative tariffs (UK and Swedish) from 1757 patients with type 2 diabetes from the Swedish National Diabetes Register (NDR). Ordinary least squares were used for statistical analysis. Lower HU was found for female gender, younger age at diagnosis, higher BMI, and history of complications. Microvascular and macrovascular complications had the most negative effect on HU among women and men, respectively. The greatest decline in HU was associated with kidney disorders (-0.114) using the UK tariff and stroke (-0.059) using the Swedish tariff. Multiple stroke and non-acute ischaemic heart disease had higher negative effect than a single event. With the UK tariff, each year elapsed since the last microvascular/macrovascular complication was associated with 0.013 and 0.007 units higher HU, respectively. We found important heterogeneities in effects of complications on HU in terms of gender, multiple event, and time. The Swedish tariff gave smaller estimates and so may result in less cost-effective interventions than the UK tariff. These results suggest that incorporating subgroup-specific HU in cost-utility analyses might provide more insight for informed decision-making